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Making Health Care Work Updates

Congress faces the challenge of transforming macro-level consensus on health care reform into detailed, workable policy. This policy primer is intended to help meet that challenge. It examines seven factors which have led to the interrelated crises in cost and quality, and prescribes specific policy remedies to tame costs and restore health professionals’ ability to provide the care on which American families rely.

As our economy weakens nationwide, Illinoisans are having a harder time accessing and affording health insurance. Illinois needs to change the way it regulates the health insurance industry to make sure residents have access to predictable and affordable coverage. An analysis conducted by the Illinois Public Interest Research Group indicates that increasing cost-containment and accountability measures for health insurance companies does not mean that the premium costs paid by consumers will increase.

Unless the new Congress and Administration act to reduce health care costs, the yearly cost of the average employer-paid family health policy in America is projected to more than double from $11,381 in 2006 to $24,291 by 2016 even after adjusting for inflation. If recent trends continue, wages and household incomes will simply not keep up with these high costs. Nor will the business sector be immune to this crisis. Unchecked, this cost epidemic could also severely impact the small businesses that drive job creation in the American economy. This report examines three important sources of this unproductive spending.

Oregon businesses and consumers are facing unsustainable increases health insurance premiums and out-of-pocket costs, with health care costs rising at more than double the rate of inflation. Given this, Oregon officials are developing a major health reform plan to cut costs, improve health outcomes, and ensure Oregonians have access to affordable quality health care. The officials charged with this task, the Oregon Health Fund Board, released a draft reform plan for public comment in early September 2008.

California spends billions of health care dollars on unnecessary treatments and services, administrative waste, and overpriced, sometimes harmful, medications. By finding ways to cut waste in its health care system and to reform an incentive structure that encourages overspending, California can reduce the burden that health care costs impose on our economy.

Drug companies spend billions annually marketing their latest, most expensive drugs to doctors. These marketing efforts do not rely solely on scientific research and medical benefits, however; they employ a barrage of gifts, expensive meals, and wine-and-dine events to gain access to doctors. The result is that doctors looking for objective data about the efficacy and safety of pharmaceuticals are ensnared by this system, and find it increasingly easy to look to the drug companies for information.

During the spring of 2006, researchers from the state Public Interest Research Groups (PIRGs) posed as uninsured customers and surveyed by phone hundreds of pharmacies in 35 cities across the country to determine how much uninsured consumers are paying for 10 prescription drugs commonly used by adults under age 65. We then compared these prices with the prices the pharmaceutical companies charge the federal government; with prices at a Canadian pharmacy; and with the results of a similar survey we completed in 2004.

Prescription drug marketers are inundating doctors, and to a lesser extent, the public, with marketing that misrepresents risks, promotes unproven uses, and makes unsubstantiated claims. The false and misleading messages are communicated through conventional advertising, sales representatives, doctors speaking on behalf of drug marketers, and through clinical trial suppression, manipulation and misrepresentation. Sadly, the Food and Drug Administration (FDA) is ineffective at addressing the problems. This report takes a comprehensive look at all of these facets of the prescription drug marketing problem and suggests effective solutions.

In late summer of 2004, the PIRGs conducted a survey of more than 400 pharmacies in 19 states across the country and Washington, DC to determine how much uninsured consumers are paying for 12 prescription drugs commonly used by adults under age 65. We then compared these prices with the prices the pharmaceutical companies charge one of their “most favored” customers, the federal government, and also with the prices paid by consumers in Canada.

In the spring of 2003, the National Association of State Public Interest Research Groups (PIRGs) conducted a survey of more than 500 pharmacies in 18 states across the country and Washington, D.C. to determine how much uninsured consumers are paying for 10 common prescription drugs. We then compared these prices with the prices the pharmaceutical companies charge one of their “most favored” customers, the federal government.